HomeMy WebLinkAboutCOUNTY CHECKLIST - 22-00207 - 2970 S Hwy 191 - Robison-Thompson ShopMADISON COUNTY ROAD DEPARTYMNT
PERMT.ClUC!"T
The, purpose of this checklist is to ensure the perm tee has completed all the necessar,
componelats of the permit ap
. plicgion. to reduce thepossibility ova delay in processing and
approving the permit
-Project Name:
El Attached a copy- of the PrOject sketch, drawing Or engineered plans (standard diagram
forms ineluded with permit. packet)
Will in a Ci . V IrapactZone, secure peitWts1p fxom authorizing City
enmSslan
Officials for servicelutiEty camections
0 Obtain other MadisonCounty pem3its.as required (bwj&,g permit, Riga perjt)
NIDUS or Qu"Ons you may have for the volmiy 0imcials,.
RIGHT.CF-WAY USE PERMIT
MADISON COUNTY ROAD DEPARTMENT
Permit' Type, New constru4iion M-glatentom—
not be v0d for excavation urs*f, or of IftocCode, THItS5, Cbepter,22 hbe heart compiled with
PRIOR T0,EXCAVATION, IDENTIFY ANY UNDERGROUND UTILMES 9YCALLIN40 A OCATORSIERVICE' 1-0004wm
—7— U011ty Type "k am*t"m
'PERMIT #
0 P)ioiqE
Est Start Qate,. 1=st-,Cornplete Data. CABLE
PERMIT E Fatal
Road Name: OPOWER Size
n,
coo Location.: GAS
Sight Distance: Post,- E! Yes 0 1vo DwvrztAi
Pubfj� Rciad Surface: SEWER
Approach Type: must meet the mwwm*.rft ottocai toottwwj -rachm-w Asoftiazze c*utc4 tLRtpqh stodad Appsoack PQ*w and Idaho ca".49-
Single -Family Residence 08
�ff Multi Family Residence No.ofUnits.
AgricultwTV n aqsine ss :, Type,
proach Width, 23'— Surface mafiinaL 0 Gravel
A 0r"e"• *Wc;ii64*
EME BESMO)ANPAWMETIOUP f van
.1 00AUMORMWOWRIESWTATIVECIFORCIF P
PVC
K PRIWISIONSAN07HE PLANS
k6mrzPART oF !M* PMrr.
Nam of Pemlfto, Wcent (if other than.
Coldwater Properties
roperties Jared Amell
0.
AddM3 of Pom;!ittee, /Applicant
2970S 191 ttT- ----
Sate ZIP D -
UWexburg 83440 J�ig
02/1.5/24
&XJK=T0AJ-L TERMS, MIMMI11% AM MV0ONSOMMObi THIS FORM OFLATWOONTS; MOOMMISNOWMANMIC
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FEE WORKSHEET
Approach /, DrivewAy Construction
Roideatijil Fos
vt
Resideigial (single and twa-fhmfly rcsidmm)
Single Appmack... ............ __ .............
Multiple Approaches - same street - ...... ............... ___ ---------- $50 'G.0
R& Street Access -------------- --------- Single approach fee $-20,
Plus .0,0
FEE:
Coo inereW Fees
Single Business
Single Approadi,
--------
Multiple Approaches — same .............. .................. 4j60,00
:Side fteet ------ single approach fee plus $20.00
FEEM.
Multi-finifly residenm (SP8rtr40uftAIDWnbomen . up to 6 dwIft unft)
Single Appmache
........ ...... w .............. .......... $60.00
Multiple Approaches some street,_.,___ ........................
Side Street Access: ---- ...... .._'single. approach fee plan $20.00
FM
Wd-familY rMidCuCeS (Vartmeatsft'%mhoxnes of or more dwelbg units} — OR -
Multiple BusineSSes (separate or mmooW Ming Ormnon pwidng 16t) — OR —
Subdivislon,WrOaCh(es)
Single Approach ,.._,-_., -� -----------
MITHMIP Qff%mof 44A An
--- --- single approach fee plus.
Agricultural Fees
FIE. :
Season zI Approich.... ..... ........ ........ --------- ..---No Pee
= Pbrucnt Approach_ .................................... ------ $40.00
FEE:
PAGE I TOTAL-
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